骨水泥网袋结合椎弓根锚定技术治疗Ⅲ期可复性Kummell病

目的探讨骨水泥网袋结合椎弓根锚定技术治疗Ⅲ期可复性Kummell病的临床疗效。方法2018年1月~2022年12月收治的Ⅲ期可复性Kummell病病人35例,均采用骨水泥网袋结合椎弓根锚定技术治疗,记录手术时间、术中失血量、骨水泥注入量、手术并发症,比较手术前、术后次日及术后3个月随访时疼痛VAS评分、ODI值、Cobb角及伤椎中线高度。结果手术时间35~63分钟,平均(45±5.8)分钟,手术失血10~35ml,平均(20±5)ml,骨水泥注入量4.5~7.8 ml,平均(5.5±1.8)ml,骨水泥漏4例,其中椎间隙漏1例,椎体侧漏2例,椎体前漏1例,无骨水泥椎管漏,所有骨水泥漏未导致临床症状,无骨水泥中毒及肺栓塞。无骨水泥团块滑移。所有病人均获得随访,随访时间12~24个月,平均(15±3.5)个月,VAS评分及Oswestry功能障碍指数(ODI)值术后第1天较术前明显降低,差异有统计学意义(P<0.05),术后3个月随访较术后第1天略增加,差异无统计学意义(P>0.05)。影像学测量伤椎中线高度及Cobb角情况,伤椎高度术后第1天较术前恢复明显恢复,Cobb角明显变小,差异有统计学意义(P<0.05),术后3个月随访伤椎中线高度较术后第1天变小,Cobb角稍增大,差异无统计学意义(P>0.05)。结论骨水泥网袋结合椎弓根锚定技术治疗Ⅲ期可复性Kummell病疗效良好,能明显减轻病人疼痛,缓解临床症状,改善脊柱功能,提高生活质量,减少骨水泥渗漏及滑移发生率。

Fabrication of NiTi Shape Memory Alloys with Graded Porosity to Imitate Human Long-bone Structure

Replacement of damaged long bones is still a significant challenge in surgery. In the present study, a NiTi Shape Memory Alloy （SMA） constructed with graded porosity imitating human long bone structure was fabricated via a dedicated moulding procedure. The outer layer （porosity 14 %） and inner layer （porosity 52 %） of the bone-like graded NiTi alloy were found to be co-axial very well with the interface with a good metallurgical bonding. Moreover, the compression strength and elastic modulus of the graded-porosity NiTi SMAs were found to be 360.6 MPa and 6.7 GPa, respectively, which have been improved by its coaxiality compared with the one with poor coaxiality. The graded-porosity NiTi SMAs exhibit resembling mechanical performance as human long-bones, and are considered to be better implant candidates for long bone replacement.